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One study conducted by Saarela et al reported an increased incidence of kidney cancer associated with type 2 diabetes mellitus (standardised incidence ratio = 1.42, 95% CI 1.37 to 1.47).1 Some of our ideas are shared with the readers. First, cancer usually has a prodromal phase, but it may be vague or non-specific, and it cannot easily be self-diagnosed by patients. Additionally, haematuria is an early feature of kidney cancer,2 but initially it may only be microhaematuria or non-visible haematuria. It is difficult to be self-diagnosed by patients. Only when it becomes visible haematuria, can it be discerned by patients.3 Clinically, it is not practical to perform urine analysis every day just for detecting haematuria. Thus, we cannot be sure of the onset date of haematuria. Second, hyperglycaemia always precedes the confirmed diagnosis of diabetes mellitus. Diabetes mellitus is a chronic condition with a long-term clinical course. It is difficult to check blood every day only for detecting hyperglycaemia. So, we also cannot be sure of …
Contributors S-WL contributed to the conception of the article, initiated the draft of the article and has approved the final draft submitted. C-LL and K-FL conducted data analysis.
Funding This study was supported in part by the Ministry of Health and Welfare in Taiwan (MOHW108-TDU-B-212–1 33 004), and China Medical University Hospital in Taiwan (DMR-107–192 and DMR-108–089), Academia Sinica Stroke Biosignature Project (BM10701010021) and MOST Clinical Trial Consortium for Stroke (MOST 108–2321-B-039–003). These funding agencies did not influence the study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.